Polyuria

Absorption of irrigation fluidsUrine osmolality <250 mOsm/kg
Serum hyponatremia
Variably presentObservationHyperglycemiaCommonDiabetes mellitus
Stress hyperglycemia
Steroid administrationGlucosuria
Pseudohyponatremia
Hypokalemia
Acidosis (DKA)
↑osmolality (HHNK)Insulin, potassium supplementationMannitolOccasionalReduction of intracranial pressure (ICP), renal protection during rhabdomyolysisSerum hyponatremia, increased osmolality, hypokalemia; rarely hyperkalemiaSelf-limitedPost-obstruction diuresisCommonBilateral ureteral obstruction causing hydronephrosisSupportiveOther diureticsUnusual



Loop




  • bumetanide



  • ethacrynate



  • furosemide



  • torsemide



Potassium-sparing




  • amiloride hydrochloride



  • spironolactone



  • triamterene



Carbonic anhydrase inhibitors




  • acetazolamide



  • methazolamide



Osmotic




  • glycerin



  • isosorbide



  • urea

VariableSelf-limitedNeurogenic diabetes insipidusUnusualProcedures of the pituitary, traumatic brain injury, craniotomy, Sheehan’s syndromeHypernatremia, high serum osmolality, low urine osmolalityDDAVP, carbamazepine, chlorpropamideHypercalcemiaUnusualHyperparathyroidism, paraneoplastic syndrome (lung, breast carcinoma)Calcium >14 mg/dlIV normal saline, loop diuretic, calcitoninNephrogenic diabetes insipidusRare


Pregnancy, craniopharyngioma, medications:




  • lithium



  • demeclocycline



  • ofloxacin



  • aminoglycosides



  • cimetidine



  • amphotericin

Hypernatremia, hyperosmolalityFurosemide, NSAIDsCerebral salt wasting syndromeRareSAH, traumatic brain injury, craniotomyHyponatremia
Low serum osmolalityIV normal salineAcute thyrotoxicosisRareGraves’ disease, thyroid stormElevated T3 or T4Supportive, treatment of hyperthyroidismHigh protein enteral feedingRareJevity, EnsureIncreased ureaDecrease protein content of enteral feedingRadiographic contrast dyeUnusualSelf-limited, hydrationRecovery from ATNRareDecreasing blood urea nitrogen and creatinineSupportiveSevofluraneRareNoneTransient

DDAVP = desmopressin, NSAIDs = non-steroidal anti-inflammatory drugs, DKA = diabetic ketoacidosis, HHNK = hyperglycemic hyperosmolar non-ketotic coma, ATN = acute tubular necrosis, SAH = subarachnoid hemorrhage



Management: Non-specific therapy for nephrogenic DI includes administration of thiazide diuretics. Administration of a diuretic in treatment of polyuria may seem paradoxical, but the increased urinary sodium losses limit free water loss. NSAIDs may limit renal free water loss by affecting renal prostaglandins. Lithium-induced DI may be specifically antagonized by amiloride. Parathyroidectomy may be curative of nephrogenic DI caused by hyperparathyroidism. Treatment of hypercalcemia will improve DI due to increased serum calcium.




Cerebral salt wasting syndrome (CSW)


CSW may develop after traumatic brain injury, craniotomy, or subarachnoid hemorrhage. Increased sympathetic outflow and inappropriate release of natriuretic proteins may lead to polyuria. The clinical presentation has significant overlap with neurogenic DI, but the volume loss includes salt wasting rather than free water. Neurogenic DI and CSW may be distinguished by laboratory findings. Management of CSW is supportive replacement of sodium and fluid losses.[16]

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Jan 21, 2017 | Posted by in ANESTHESIA | Comments Off on Polyuria

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